by Lauren Miller
Hi! My name is Lauren and I am a second year medical student at the University of Pennsylvania. I’m involved with Elizabeth Blackwell Society (EBS), which is the most inspiring name for a group because Elizabeth Blackwell was a champ (the first woman to receive a medical degree in 1849, driven by her desire to give females a better reputation). Our main goal this year for EBS has been to help empower and connect women in medicine. Through this club, I have realized how important it is for us – women AND men – to support women in their endeavors. Women in medicine make up half of the workforce, so equal pay, equal promotion opportunities, and equal social rights are of benefit to everyone. Discussions with medical faculty have highlighted that many women in medicine care deeply about this issue-- even if they are not vocal about it.
Remember when I said one of our main goals for EBS was to connect women in medicine? I think that in some ways, we didn’t fully meet this goal. We did a great job of connecting female medical students with female physicians. But looking back, I realized that we made no attempt to connect women across all of healthcare, which made me wonder if this is actually a much larger problem. So I met up with a friend of mine, Kate, who is currently a nurse working in an ICU and also studying to become a nurse practitioner. We chatted about the relationship between nurses and doctors that Kate has experienced, as well as the differences in respect granted to female and male physicians.
Remember when I said one of our main goals for EBS was to connect women in medicine? I think that in some ways, we didn’t fully meet this goal. We did a great job of connecting female medical students with female physicians. But looking back, I realized that we made no attempt to connect women across all of healthcare, which made me wonder if this is actually a much larger problem. So I met up with a friend of mine, Kate, who is currently a nurse working in an ICU and also studying to become a nurse practitioner. We chatted about the relationship between nurses and doctors that Kate has experienced, as well as the differences in respect granted to female and male physicians.
We started the conversation by discussing what relationship Kate holds with female physicians and if it differs at all with her relationship with male physicians. Kate immediately responded that it totally varies with the physician. There are, in her mind, two distinct types of relationships that she has with physicians. “The first relationship is with those physicians who are incredibly passionate about patient care and education, including the education of nurses. Some nurses won’t admit this, but a large proportion of the time they don’t know why they are doing the things they are doing – they are just doing it. And that is a really frustrating thing! Doing something blindly because someone else told you to do it makes it really hard to grow, to learn, or to provide the best care. So when physicians take the time to explain why they are ordering this test or why the nurse needs to check a vital sign on the patient every twenty minutes is incredibly helpful.”
“These types of physicians are also the type that regularly seek feedback. They will ask the nurses whether the action performed on the patient made any impact, or if it was comfortable for the patient. Nurses have practical, real time feedback about the basic function of the patient. And these moments of feedback and different perspectives lead to huge opportunities for growth from all sides. As a result, these physicians’ opinions are highly valued because they actually care about the patient, so when they ask for something I will do it immediately. I never worry that the patient’s care is being compromised in any way with these physicians. And this definitely isn’t a gender matter, but a personality difference.”
“These types of physicians are also the type that regularly seek feedback. They will ask the nurses whether the action performed on the patient made any impact, or if it was comfortable for the patient. Nurses have practical, real time feedback about the basic function of the patient. And these moments of feedback and different perspectives lead to huge opportunities for growth from all sides. As a result, these physicians’ opinions are highly valued because they actually care about the patient, so when they ask for something I will do it immediately. I never worry that the patient’s care is being compromised in any way with these physicians. And this definitely isn’t a gender matter, but a personality difference.”
...these moments of feedback and different perspectives lead to huge opportunities for growth from all sides."
I then asked her about the second type of relationship (the physicians not quite as concerned with patient care). “The second type is with those who basically don’t do any of those things. They are competent, but they don’t have that same passion of caring for their patients. My relationship with these physicians is challenging. I end up calling him or her way more over any complication the patient may have because I worry. That same level of reassurance and trust is not there. And if the patient gets hurt, we all lose. So this is where the nagging-nurse-calling-all-the-time idea arises, which leads to a tense cycle.”
I wondered if this mentality resonated across her team, or if she was the exception. While there is always a spread of personalities and approaches, she said that generally, those physicians that care the most get the greatest respect and are easiest to work with. She acknowledges that some nurses get along better with male physicians if there is any sort of physical attraction, but sexual tension between doctors and nurses is really over-hyped in the media. She mentions that rather, the bigger problem that arises too often is the inability to set egos aside. “There are too many physicians and nurses who cannot do this and assume that he or she knows best at all times. However, I have learned that (patiently) taking the time to explain my perspective has helped me more than anything. Because ultimately, these people are still on your team and working with them is actually your only choice.”
I wondered if this mentality resonated across her team, or if she was the exception. While there is always a spread of personalities and approaches, she said that generally, those physicians that care the most get the greatest respect and are easiest to work with. She acknowledges that some nurses get along better with male physicians if there is any sort of physical attraction, but sexual tension between doctors and nurses is really over-hyped in the media. She mentions that rather, the bigger problem that arises too often is the inability to set egos aside. “There are too many physicians and nurses who cannot do this and assume that he or she knows best at all times. However, I have learned that (patiently) taking the time to explain my perspective has helped me more than anything. Because ultimately, these people are still on your team and working with them is actually your only choice.”
On the topic of physical appearance and respect as a physician….
“It’s interesting, I think it is pretty well known that the more attractive the male physician is, the more he is liked on a unit (but I should preface this by saying that this comes AFTER it is determined that he is a competent, compassionate guy. Refer to types of physicians from above. If you are attractive but incompetent you get the “pretty boy” label, which is equally undesirable). However, I think it actually hurts the female physician if she is particularly attractive. I feel like they come in against the stereotypes of ‘you are pretty, you are a physician, you must not understand how the real world works. Your father is probably a physician too and he paid for your medical school.’ I know this seems harsh but this is definitely a thing that happens on my unit. The attractive female physicians render very little respect from their male physicians or from the nurses. They also get some unfair rumors spread about them – if you page one of these physicians and she doesn’t call back right away, multiple people on multiple occasions have responded to this by saying that she is probably hooking up with “____________” in the call room. But this would never be said about the attractive male physicians. The worst thing is there are about 5 female physicians that work on our unit that undergo these accusations– and frankly, all five of them are incredible physicians. I can’t speak for other units or other institutions, and it is possible that my unit is still backwards – but it definitely happens.”
On the topic of medical and nursing education…
“I think it would be really interesting to incorporate more joint medical and nursing education. I know how busy you guys are in med school, but my nursing school did a ton of team-based learning with other health care students. We did mock codes and simulations with PT students, OT students, PA students, respiratory technicians… but never with any med students, which is pretty unpractical. I personally loved these mock trials as they helped you figure out how you would operate in an intense situation. The best part is the ‘debrief’ that happens at the end. Everyone has to provide feedback and we brainstorm on how to optimize the results of scenario. Lots of unknown biases are always revealed and I think this would be so beneficial for nursing and med students to do together.”
Final last words…
“We [nurses] are here to help you. We are here to carry out your orders and to be your eyes and ears when you can’t be. To communicate and to show that we can trust each other really goes a long way, and to just take that extra minute at the morning of rounds, just ONE MINUTE to explain to the nurses what the plan of care is for the day – you have no idea how much that helps us. And the patient can see this too – the patient always senses how well (or even if) the nurse and physician is communicating. Also, spend some time at the nurse’s station. It’s not hard to ask a nurse how their shift is going, what they are doing that evening, or just if they need anything from you. Last thing, remember: people don’t care how much you know until they know how much you care.”
I have always known that the dynamics of the Doctor-Nurse relationship has been dissatisfying for many. While I can’t say whether or not other nurses would completely resonate with Kate’s perspective, I think all would agree that striving for transparent communication and doing what is best for the patient is the most crucial objective. Looking forward (to the beginning of my clerkship year in January), I have tweaked my approach to the clinics since speaking with Kate. In this next year, one of my goals is to learn how to think from a physician’s perspective. However, Kate reminded me that I will never be able to achieve this goal alone; thinking like a doctor requires me to think like a good team player.
